Editor’s Note: Syra Madad, an infectious disease epidemiologist and science communicator, is the senior director of the systemwide special pathogens program at NYC Health + Hospitals, and fellow at the Belfer Center for Science and International Affairs. She tweets @syramadad. The views expressed in this commentary are her own. View more opinion at CNN.
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My family was first infected with Covid-19 in April 2020 — a daunting and frightening experience at a time when casualties from the pandemic were mounting in New York City and no vaccine or effective treatment was in sight.
When most of us were reinfected in January this year, I was disappointed, given that we are up to date with vaccinations and generally wear masks in high-risk settings. But reinfection is the norm for many and we’ve recovered this second time around. While I still experience a chronic cough and postnasal drip, it’s been a nuisance more than anything else.
Our second experience was a far cry from the first — thanks to the availability of vaccines and other therapeutics.
But many of the antibody drugs are no longer effective due to the rapid evolution of the virus and its many subvariants. The US government desperately needs to continue to invest in more Covid therapeutics to keep up with the evolving nature of the virus.
The Biden administration has already announced its intent to end the public health emergency declaration for Covid-19 on May 11, after more than three years. The national crisis peaked in early 2021, with more than 4,000 deaths per day from Covid-19 (subsequent waves, like the one caused by Omicron, were also incredibly deadly). Now, the latest data from the US Centers for Disease Control and Prevention shows there are fewer than 2,300 deaths per week. This reduction is thanks, in part, to vaccines, therapeutics and more immunity in our communities.
But the virus that causes Covid-19 has not disappeared. Based on the CDC’s weekly count, Covid-19 still kills an average of about 327 Americans every day. For comparison, lung cancer causes more than 350 deaths each day in this country — the highest number of deaths for all types of cancer, according to the American Cancer Society. There are still massive efforts made to educate the public on lung cancer prevention, screening and treatment. And research, as well as the search for better treatment, hasn’t stopped. So why should we accept anything less for Covid-19?
The reality is the rapid evolution of Covid-19 and its subvariant offspring has severely limited our arsenal of effective therapeutics, especially for the immunosuppressed.
Over the last two years, the US Food and Drug Administration has rescinded the authorization of five antibody therapies because Omicron’s subvariants have rendered them ineffective.
In November, with a new sublineage of Omicron taking off, the FDA rescinded the emergency use authorization for the antibody therapy bebtelovimab, a drug used for the treatment of mild to moderate Covid-19 in adults and pediatric patients.
Fast-forward two months, and the rapid growth of the XBB sublineage of Omicron started to dominate US Covid cases in January. The FDA rescinded its emergency use authorization of Evusheld, a long-acting antibody combination used to prevent Covid-19 in immunocompromised people who don’t mount an adequate immune response to Covid-19 vaccination and those for whom vaccination is not recommended.
What remains for those who are not hospitalized but face high risk for severe illness from Covid-19 are antivirals such as Paxlovid, Remdesivir and Molnupiravir as well as convalescent plasma for some patients, all of which come with their own limitations. Fortunately, some pharmaceutical companies have said they will continue to do research and evaluate other antibody therapy candidates.
But the quest for other and more effective therapeutics is just one part of the challenge. The need for more effective Covid-19 vaccines that block transmission is another.
We must continue to invest in better vaccines, especially as studies indicate some people who have recovered from Covid-19 remain at increased risk of developing cardiovascular complications up to a year later. It’s one among many other documented long-term health effects of the disease on the brain, kidneys, and lungs. Adding to the dilemma is the increased risk reinfections pose. A study has shown that repeatedly catching Covid-19 increases the chance a person will face new and sometimes lasting health problems.
Not to mention there’s still the risk of long Covid, an umbrella term for a vast number of new, returning or ongoing health problems people experience after being infected. While it’s still hard to gauge how many people go on to experience long Covid, a 2022 survey by the US Census Bureau found that around 16 million working-age Americans (ages 18 to 65) have long Covid, and of those, 2 to 4 million are out of work as a result.
Don’t get me wrong, our current vaccines are lifesaving and serve the purpose of preventing severe outcomes caused by Covid-19. Over 671 million doses of Covid-19 vaccines have been administered in the United States since December 2021, according to the CDC. That’s about 80% of the US population receiving at least one dose, a monumental public health achievement.
A new analysis from the Commonwealth Fund found that since the Covid-19 vaccines became available, vaccination has prevented more than 18 million hospitalizations and averted more than 3 million deaths in the US. The vaccination program also “saved the U.S. more than $1 trillion in medical costs, and has preserved hospital resources, kept children in school, and allowed for reopening of businesses and other activities,” it said. Covid-19 vaccines even help reduce the risk of long Covid, one study found. But we need to step up our vaccine game.
The last Congress did not fund next-generation Covid-19 vaccines or treatment and it seems unlikely that our current Congress will do so either. But we are in desperate need of an Operation Warp Speed 2.0 as we continue to experience the evolution of this virus, which has been chipping away at the protective wall of immunity we’ve built over the last few years. To stop funding now would be foolish.
The good part is we’re not starting from scratch. Places such as the Center for Infectious Disease Research and Policy, which recently unveiled a road map for advancing better Covid-19 vaccines, are doing good work. But funding and political commitment are necessary — not just scientific expertise and resources.
As I reflect on the last three years of the pandemic, it wasn’t the failure of science or technology that stumped us. On the contrary, scientific breakthroughs meant we had two lifesaving Covid-19 vaccines at our disposal roughly a year after the novel coronavirus first emerged. What hurt us most was our failure of imagination.
It is wishful thinking to assume that the virus that causes Covid-19 is done with us. To sit around and grow complacent while the virus continues to mutate, potentially leading to newer and more serious variants, would be a huge mistake.
